Diagnosis of abusive head trauma (AHT) is challenging; clinical signs are non‐specific and perpetrator confessions are rare. Moreover, many infants sustain multiple episodes of abuse before presenting to medical practitioners. The objective of this study was to quantify the incidence of prior presentations with features of brain injury in AHT, and to compare these figures to those in non‐abusive head trauma (non‐AHT). Data on children under the age of two years who were assessed for AHT by the Child Protection Unit of Sydney Children's Hospital between 2008 and 2017 were collected, and AHT cases were compared with non‐abusive cases. Of the 167 cases assessed for head trauma, 26 per cent had at least one prior presentation to medical care. This was 42 per cent of the AHT cases, and 11 per cent of the non‐AHT cases. Odds ratio calculations revealed infants with AHT were 5.7 times more likely to have had a prior presentation than children with non‐AHT (CI = 2.4–13.17, p < 0.001). Infants with AHT are much more likely than infants with non‐AHT to have presented previously to medical practitioners. This difference suggests that there is an early diagnostic window within which abuse can be detected before it continues or escalates. Careful evaluation of an infant is of paramount importance, and may save a life.

中文翻译：

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婴儿头颅外伤：先前脑损伤的发生率和检测

滥用性颅脑外伤（AHT）的诊断具有挑战性。临床体征是非特异性的，施暴者的认罪很少。此外，许多婴儿在看医生之前会遭受多次虐待。这项研究的目的是量化AHT中具有脑损伤特征的先前报告的发生率，并将这些数字与非虐待性头部创伤（non-AHT）的发生率进行比较。收集了悉尼儿童医院儿童保护部门在2008年至2017年之间对AHT进行评估的2岁以下儿童的数据，并将AHT病例与非虐待性病例进行了比较。在评估的167例头部外伤病例中，有26％曾至少接受过一次医疗护理。这是AHT病例的42％，非AHT病例的11％。p <0.001）。患有AHT的婴儿比未患有AHT的婴儿更早以前就医过。这种差异表明存在一个早期诊断窗口，可以在此窗口中检测到滥用行为，然后继续进行或升级。仔细评估婴儿至关重要，可以挽救生命。